HomeMy WebLinkAboutSWG2022-00413 - SWG As-Built - 10/23/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2022-00413 Parcel# 32021-58-04027
Applicant Name Paul Hemming Subdivision (Name/Div/Block/Lot)
Applicant Address 2661 N Pearl St#169 Shorecrest Beach Estates Block 4 Lot: 27
City. State, Zip Tacoma, WA 98407 Installer Name Mason County Excavating
Site Address 41 E Lynwood Dr, Shelton Designer Name Arrow Septic Designs, Inc
INSTALLATION CHECKLIST
Q Full System Installation ❑Tank(s) Only ❑ Drainleld Only ❑ Repair ❑ other
System Type Shallow Pressure Pretreatment Type
>5 ft from foundation? - ❑ N/A 0 YES ❑ NO
>50 ft from wells? - - ❑� ❑ ❑
i >50 ft. from surface water? - - - • 0 0
< Cleanout between building and tank? ❑ ❑� ❑
O Tank baffles present? - ❑ ® ❑
P• 24"access risers over each compartment? ❑ ❑� ❑
a ❑ E ❑
W Effluent filter installed?-
m
Septic tank capacity (working) 1,200 gal Manufacturer Hagerman
O D-box water level and speed levelers used? • NIA ❑ YES ❑ NO
QOJ Manifold/D-box accessible from surface?-
❑ IN ❑
mz Check valves installed? - Q'� Qua,* 44 ❑ El ❑
64
2 Transport Line Size 2" Schedule/Class 40
Bedrooms installed (check one) ❑ 2 ❑� 3 ❑4 0 5 ❑6 ❑CommercialiOther
>10 ft. from foundation? ❑ NIA O YES ❑ NO
0 >100 N. from wells?- El ❑ ❑
J >10o ft. from surface water" - - ID ❑
LT >1 o ft.from potable water lines? s�e'�e� - ❑ ❑ 0
2 > 5 ft. from property lines and easements?- - ❑ 0 ❑
K > 30 ft from downgradient curtain/foundation drains? - - - - - - II ❑ ❑
O Drainfield level and observation ports present - ❑ . 0
❑ Graveless chambers or • Clean gravel used? (check one)
Proper cover installed over drainfeld?- - ❑ ED 0
Pump tank setbacks consistent with septic tank? ❑ NIA Q YES ❑ NO
Y Pump tank capacity (flood) 1,000 gal Manufacturer Hagerman
2
4 24"access riser(s) and accessible from surface? ❑ 0 ❑
~ Alarm or Control Panel installed? - • ❑ . ❑
0-
2 Control Panel equipped with Timer/ ETM /Counter- - 0 El ❑
C- Pump Metaled in ❑ Bucket or I I On Block or ❑ Other
d Pump Make/Model AYMacDonald404011EFA,4/10hp,115v • Floats or ❑ Transducer
C Tank draw down 2.5 in/min Pump capacity 45 gpm Squirt Height 4 ft
Pump on time 2 min Pump off time 6 hr Daily flow set at 360 gpd
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Parcel# 2O2- _5 8 — 9--Mason County OSS Installation Report pg. 2
ABANDONMENT RECORD
Yes Id NO
Were existing septic components abandoned as pan of this project? `f�'�
If yes, please describe: 0 YES E No
Were all components pumped out and properly abandoned per WAC246-272A-C3002
RECORD DRAWING
This is a permanent record and must be accurate and descriptive enough to re-locate in the need of maintenance actiJNm and future development Typ®I Record
g and
gs.location
[Mamma contain: Drabteld&reamed onentaton&layout Septwpump'tnk location,No=arrow.reserve mere daeam add erne delays in proposed
°Hidimm�approval f and wets.waterlines,
ernenes,
welly 'o en'aton ports.deanaut,and other maintenance access points. Incomplete Record Dn+an
s.
0. r--7---
Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
I certify that I installed the system in accordance with I certify that the system has been installed in accor-
the septic design stamped"APPROVED"by Mason dance with the septic design stamped"APPROVED"by
County Public Heatth and that any deviations shown Mason County Public Health and that any deviations
here have been cleared/approved by both the designer shown hem have been cleared/approved by both
and Mason County Public Health and meet all State myself and Mason County Public Health and meet all
and Mason County Codes. State and Mason County Codes
I further certify that all information contained on this I further certify that all information contained on this
form and attagfied Record Drawing is accurate. form and attached Record Drawing is accurate.
ORI24/Z3 -I
Signature of Installer
Date t
Fc'Acvn ktrV-. _
l:h.
Punted Name of Signet �s! d`*a••'1^i.
MASON COUNTY PUBLIC HEALTH .-►!)\f 4 %art'
The undersigned approves this Installation Report and H.
�j' stcoaaa .•Nyl'h
Record Drawing on behalf of Mason County Public pAuu uor doBNSaN'-. Y•
CRC S_Ct�'� 51GNEN" i
Health: � sEs (1 c�
y<e f logo fr23
Signature of Environment Health Specialist Date (stamp, signature and date)
This FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE UWatxaztrzms
N5f115ukLTC •
APPROVEL
Parrriig32o21-5k-04027 OCT 23 2023
Att ? Lynwood Ar. YAWN Couti TY<<,vraervE NraLNE4irK
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GOMc2ONENTS
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VI. / / Audio-Visual Alarm
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/ ti / / 3 Cleanout
/ / / �` C3 1200 Gallon Septic Tank
q yy 2-Compartmer_i with
x' / / 9 /q / v// / Effluent Filter
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PAULA JOY JOHNSON "•,�
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